Active immunotherapy mobilizes the antitumour immune response and complements standard treatment of colorectal cancer, including at advanced stages
In colorectal cancer, surgery performed in time can lead to full recovery. Things are worse at advanced stages: once the tumour can no longer be removed radically, chemotherapy does not always shift the prognosis much.
That is where immunotherapy comes in: it mobilizes the patient's own antitumour immune response and complements standard treatment where its options are limited.
The molecular status of the tumour deserves a separate mention, because it decides which immune approaches work at all. Roughly one in twenty patients with metastatic colorectal cancer has a tumour with microsatellite instability (MSI-H) or mismatch repair deficiency — such tumours respond well to checkpoint inhibitors, and those are where treatment should start. For the rest, with microsatellite-stable tumours, these drugs are largely ineffective, and it is this group that most often has nowhere to go once chemotherapy is exhausted.
The second feature of the diagnosis is the liver. Liver metastases were present in 27 of the 37 patients in the group above, and that is typical: colorectal cancer spreads first of all through the portal vein. If liver lesions are resectable, surgery is discussed first and immunotherapy only afterwards as support. If they are not, the method is considered as part of systemic treatment.
Bowel tumour cells carry antigens that set them apart from healthy ones. The trouble is that the immune system gets used to them and stops reacting.
The tumour grows slowly and for a long time, and the immune system has time to get used to its antigens and stop treating them as foreign. The point of a vaccine approach is to break that habituation and present the tumour antigens again in a form the immune system has to answer.
The tumour grows slowly and for a long time, and the immune system has time to get used to its antigens and stop treating them as foreign. The point of a vaccine approach is to break that habituation and present the tumour antigens again in a form the immune system has to answer.
The product is prepared individually from the patient's own cells. That is the fundamental difference from an off-the-shelf drug: the composition is defined by the particular patient, not by a manufacturing batch.
The product is prepared individually from the patient's own cells. That is the fundamental difference from an off-the-shelf drug: the composition is defined by the particular patient, not by a manufacturing batch.
Administration is subcutaneous and outpatient. A local reaction at the injection site and a temperature in the first 24 hours indicate that the immune response is forming. The absence of a reaction is informative too and is taken into account.
Administration is subcutaneous and outpatient. A local reaction at the injection site and a temperature in the first 24 hours indicate that the immune response is forming. The absence of a reaction is informative too and is taken into account.
Progress is tracked through CEA, blood counts and CT of the abdomen and chest. A clinical effect means a complete or partial response, or stabilisation for at least six months — that is the criterion behind the 62 % in the study above.
Progress is tracked through CEA, blood counts and CT of the abdomen and chest. A clinical effect means a complete or partial response, or stabilisation for at least six months — that is the criterion behind the 62 % in the study above.
37 vaccinated patients with stage IV disease and 37 control group patients, matched by sex, age, localization, and tumor spread.
| Characteristic | Study Group | Control Group |
|---|---|---|
| Men / Women | 20 / 17 | 20 / 17 |
| Average age, years | 61.1 (38–79) | 48.2 (30–80) |
| Metastases: lymph nodes, soft tissues | 17 (46%) | 17 (46%) |
| Metastases: lungs | 8 (22%) | 6 (16%) |
| Metastases: liver | 27 (73%) | 19 (51%) |
| Metastases: other organs | 11 (30%) | 8 (22%) |
| Prior treatment: surgery | 19 (46%) | 17 (46%) |
| Prior treatment: surgery + chemotherapy | 8 (22%) | 6 (16%) |
All patients in the study group had disseminated cancer. The best results are expected when treatment starts immediately after conditionally radical surgery.
achieved a clinical effect
complete, partial response, or stabilization for at least 6 months (23 out of 37)
survivors by the end of observation
versus 3% (1 patient) in the control group
reliability of differences in 2-year survival
compared to the control group
Below are clinical cases of long-term stabilization in disseminated colorectal cancer.
Patient K., 46 years old
Stage III transverse colon cancer, poorly differentiated adenocarcinoma
Baseline
After colon resection, a 15 mm focal lesion in the liver was found — vaccine therapy was started. An additional mass 34 × 27 mm was found in the retroperitoneal space; therapy was intensified.
After 2 years
Ultrasound and CT showed no secondary changes in the liver. After 2.5 years, reconstructive surgery was performed — no signs of progression were noted.
Observation period
4 years after the start of treatment, the patient's condition remained satisfactory, with no signs of the disease observed.
No signs of disease — observed for 4 years
Patient T., 51 years old
Mucinous adenocarcinoma of the sigmoid colon
Baseline
Admitted with acute bowel obstruction; conditionally radical resection of the sigmoid and conglomerate was performed. Vaccination started under a standard regimen.
Dynamics
A 45 × 41 mm tissue mass in the left retroperitoneal space persisted, without negative dynamics during therapy.
Observation period
3.5 years after starting vaccine therapy, the patient felt well, with no signs of disease progression.
Stable condition — observed for 3.5 years
The best results are achieved when immunotherapy is started immediately after conditionally radical surgical intervention.
The decision depends on the molecular status of the tumour and on whether the liver lesions are resectable.
After radical surgery with a high risk of recurrence; disseminated disease where radical surgery is impossible; progression after the lines of chemotherapy are exhausted. The best results are expected when treatment starts right after conditionally radical surgery.
If the tumour is MSI-H or dMMR, checkpoint inhibitors are the first-line standard and that is where to start. If the status has never been determined, that is the first thing to do; the test is run on the existing tumour block.
Acute infections, flare-ups of inflammatory bowel disease, decompensation of severe concomitant disease, pregnancy, conditions with deliberate immunosuppression. Bowel obstruction and unresolved postoperative complications require the surgical problem to be solved first.
The method does not cancel prescribed regimens. The doctor sets the intervals between procedures around the chemotherapy cycles and blood counts: during deep neutropenia or anaemia a procedure is postponed.
Treatment is outpatient; no hospital stay is needed. The induction stage runs for several months, after which the schedule follows the response. For patients from other cities, visits are grouped so one trip covers as much as possible.
The immunorehabilitation course for tumour diseases costs from 285 000 ₽ and can be paid in stages. A consultation with the professor costs 10 000 ₽, with the oncologist 7 000 ₽.
The method works best when treatment is started right after conditionally radical surgery.
The method is also applicable in advanced stage IV disease, when the options of standard treatment are limited.
Immunotherapy mobilizes your own antitumor immunity without placing a heavy toxic burden on the body.
In the centre's study a clinical effect was seen in 62 % of patients and survival reached 27 % against 3 % in the control group. The product is prepared individually from the patient's own cells.
Yes. Immunotherapy helps control the tumour process and reduce the risk of metastasis, complementing standard treatment.
The method has a gentle profile and minimal side effects compared with aggressive chemotherapy.
Yes. The centre is next to Moscow (Khimki, Skhodnya) and accepts patients from other regions; the first consultation can be done remotely from your documents.
The histology report, the discharge summary after surgery, recent CT of the abdomen and chest with written reports, CEA dynamics and, if it was done, the MSI or MMR test result.
This is a comparison of 37 vaccinated patients with a control group of the same size, not a randomised phase III trial. The groups differed in mean age and in the share of liver metastases, and that should be kept in mind.
The course costs from 285 000 ₽ and can be paid in stages. The centre issues the contract, receipts and a certificate of payment for medical services for a tax deduction.
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